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Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients

Erektile Funktion nach Brachytherapie, externer Radiotherapie oder radikaler Prostatektomie bei Prostatakrebs-Patienten

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Abstract

Background and purpose

For localized prostate cancer, treatment options include external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT). Erectile dysfunction (ED) is a common side-effect. Our aim was to evaluate penile erectile function (EF) before and after BT, EBRT, or RP using a validated self-administered quality-of-life survey from a prospective registry.

Material and methods

Analysis included 478 patients undergoing RP (n = 252), EBRT (n = 91), and BT (n = 135) with at least 1 year of follow-up and EF documented using IIEF-5 scores at baseline, 6 weeks, 6 months, 1 year, and annually thereafter.

Results

Differences among treatments were most pronounced among patients with no or mild initial ED (IIEF-5 ≥ 17). Overall, corrected for baseline EF and age, BT was associated with higher IIEF-5 scores than RP (+ 7.8 IIEF-5 score) or EBRT (+ 3.1 IIEF-5 score). EBRT was associated with better IIEF-5 scores than RP (+ 4.7 IIEF-5 score). In patients undergoing EBRT or RP with bilateral nerve sparing (NS), recovery of EF was observed and during follow-up, the differences to BT were not statistically significant. Overall age had a negative impact on EF preservation (corrected for baseline IIEF).

Conclusion

In our series, EF was adversely affected by each treatment modality. Considered overall, BT provided the best EF preservation in comparison to EBRT or RP.

Zusammenfassung

Hintergrund und Ziel

Die externe Radiotherapie (EBRT), die radikale Prostatektomie (RP) sowie die Brachytherapie (BT) stellen Behandlungsoptionen für das lokalisierte Prostatakarzinom dar. Die erektile Dysfunktion (ED) ist eine häufige Nebenwirkung dieser Therapien. Unser Ziel war es, die penile erektile Funktion (EF) vor und nach BT, EBRT und RP mit Hilfe eines validierten, vom Patienten ausgefüllten Lebensqualitätsfragebogens aus einer prospektiven Datenbank zu beurteilen.

Material und Methoden

Mit einer minimalen Nachbeobachtungszeit von einem Jahr wurden 478 Patienten analysiert, die eine RP (n = 252), EBRT (n = 91) oder BT (n = 135) erhalten hatten und deren EF mit dem IIEF-5-Score vor Therapie sowie nach 6 Wochen, 6 Monaten, nach einem Jahr und danach jährlich ermittelt worden sind.

Ergebnis

Die größten therapiebedingten Unterschiede wurden bei Patienten ohne oder nur mit milder initialer ED beobachtet (IIEF-5 ≥ 17). Korrigiert für die EF und das Alter bei Therapie, war die BT mit höherem IIEF-5-Score assoziiert als die RP (+ 7,8 IIEF-5-Score) oder die EBRT (+ 3,1 IIEF-5-Score). Die EBRT war mit einem besseren IIEF-5-Score assoziiert als die RP (+ 4,7 IIEF-5-Score). Bei Patienten mit bilateraler nervenschonender RP oder einer EBRT wurde eine Erholung der EF beobachtet; im Verlauf war der Unterschied zur BT nicht mehr statistisch signifikant. Insgesamt hatte ein höheres Alter einen negativen Einfluss auf die Erhaltung der EF (korrigiert für Ausgangs-EF).

Schlussfolgerung

In unserer Serie verschlechterte sich die EF durch alle Therapieformen. Insgesamt bot die BT die beste EF-Erhaltung verglichen mit der EBRT oder RP.

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Authors and Affiliations

  1. Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    P. M. Putora, K. Buchauer & L. Plasswilm

  2. Department of Urology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    D. Engeler & H. P. Schmid

  3. Clinical Trials Unit, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    S. R. Haile & N. Graf

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  1. P. M. Putora
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  2. D. Engeler
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  3. S. R. Haile
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Correspondence to L. Plasswilm.

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Conflict of interest

P.M. Putora, D. Engeler, S.R. Haile, N. Graf, K. Buchauer, H.P. Schmid, and L. Passwilm state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form).

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P. M. Putora and D. Engeler contributed equally to the work.

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Putora, P.M., Engeler, D., Haile, S.R. et al. Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients. Strahlenther Onkol 192, 182–189 (2016). https://doi.org/10.1007/s00066-015-0928-x

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